Proposed Entry Criteria for Postoperative Cardiac Extracorporeal Membrane Oxygenation After Pediatric Open Heart Surgery

: While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperativ...

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Bibliographic Details
Published in:	Artificial organs Vol. 23; no. 11; pp. 1010 - 1014
Main Authors:	Trittenwein, Gerhard, Pansi, Heike, Graf, Bernadette, Golej, Johann, Burda, Gudrun, Hermon, Michael, Marx, Manfred, Wollenek, Gregor, Trittenwein, Hildegard, Pollak, Arnold
Format:	Journal Article
Language:	English
Published:	Boston, MA, USA Blackwell Science Inc 01-11-1999
Subjects:	Adolescent Adult Age Factors Analysis of Variance Blood Pressure Body Weight Cardiac Output, Low - etiology Cardiac Output, Low - therapy Cardiac Surgical Procedures Central venous oxygen saturation Child Child, Preschool Congenital heart disease Critical Care Extracorporeal Membrane Oxygenation Extracorporeal membrane oxygenation entry criteria Forecasting Heart Defects, Congenital - diagnosis Heart Defects, Congenital - surgery Hospital Mortality Humans Infant Lactate Lactates - blood Logistic Models Odds Ratio Outcome Assessment (Health Care) Oxygen - blood Patient Admission Patient Selection Postoperative Care Postoperative extracorporeal membrane oxygenation Retrospective Studies
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Summary:	: While extracorporeal membrane oxygenation (ECMO) is being used increasingly after pediatric cardiac surgery, criteria are lacking for initiating ECMO after bypass weaning. To develop clinically useful ECMO entry criteria based on parameters readily available, children were examined at postoperative pediatric intensive care unit (PICU) admission. Using hospital mortality as the primary outcome, univariate and multiple logistic regressions were performed to estimate the predictive value of clinical (age, weight, and diagnosis) and laboratory (arterial blood pressure, pH, lactate, creatine kinase, and arterial and central venous oxygen saturation [ScvO2]) variables. Data from 218 children over a 2 year period were analyzed retrospectively. Univariate regression demonstrated that age, weight, diagnosis, blood pressure, venous and arterial saturation, and lactate were significantly associated with postoperative mortality (p < 0.05). In multiple regression, ScvO2 and lactate level were found to be independent predictors and were used in a predictive model (ScvO2 odds ratio: 2.03–828.6, p = 0.016) (lactate odds ratio: 1.58 –4.20, p = 0.0002) (R2 = 0.70). Applying an 80% risk of mortality to establish entry criteria as in neonatal ECMO, PICU admission values of lactate > 70mg/dl if ScvO2 < 60% or lactate >163mg/dl if ScvO2 > 60% are proposed to serve as postoperative ECMO entry criteria if bypass weaning has been possible but is followed by low cardiac output.
Bibliography:	istex:E196E0C2F4C2FA833AD01C2F230462D984BD8090 ark:/67375/WNG-29RZGVQP-K ArticleID:AOR6457 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0160-564X 1525-1594
DOI:	10.1046/j.1525-1594.1999.06457.x